Study cites benefits of telehealth; commentary says mental telehealth is 'clinically equivalent to in-person care'

As people across the nation have been asked to shelter in place because of the novel coronavirus, never before has the importance of telehealth, especially for mental-health care, become more evident, says a commentary in The Journal of Rural Health. 

The authors assert that mental-health therapy over video platforms "has been demonstrated as clinically equivalent to in-person care."

Before the pandemic, they write, video-to-home telehealth services for mental-health care was not uniformly offered, but has since gained some traction, especially in rural areas where mental-health provider shortages are great.

The authors note that telehealth visits have ensured continuity of care during stay-at-home orders, all while minimizing physical contact to keep both patients and providers safe.

But they also recognize that this type of care also comes with many challenges, including overburdened networks, poor internet bandwidth, inconsistent internet service, a lack of equipment,  billing and scheduling challenges, and usability issues for both providers and patients. These challenges have resulted in some providers conducting phone-only visits, especially after federal rules were relaxed to allow reimbursement for such visits.

But the authors say that in this time where "the loss of in-person contacts has never been more pronounced," phone-call appointments, while efficient, don't offer the same connection that video-based meetings do.

"During this pandemic, we believe that visual contact remains crucial; thus institutions that work to facilitate the availability of [video-to-home] visits will significantly benefit both patients and providers,"  they write. "Robust telehealth programs require a significant commitment of time and resources, and large health care organizations with the foresight to invest in telehealth are poised to transition [mental health] care from in-person to virtual visits."

The authors say they regularly collect patient input through interviews about virtual appointments, and have found that many patients say the video connection makes it more personal and that seeing their provider during the therapy session is "very important." Further, patients have told them that they are more comfortable getting their mental-health care at home.

"We believe that prioritizing video over phone-only calls will help maintain the integrity of [mental health] care by maintaining important social rhythms, supporting rapport, and offering a more patient-centered care approach," they write.

They add that such visits allow for the re-establishment of "social rhythms" that many patients prefer, and let the patient and the provider see nonverbal communication cues that would otherwise be missed. It also allows the provider a window into their patient's physical space, the authors write.

Video-to-home "may help patients share more with their provider within the context of therapy by enhancing the therapeutic relationship and allowing providers to establish connections that could never be achieved over the phone," they write.

The authors conclude that video-to-home "will become part of the new normal in the post-pandemic period" and say that now is the time to build competency and capacity for it.

In particular, they note that video-to-home care has been quite successful in rural Veterans Health Administration treatment centers.

A study, also published in The Journal of Rural Health and named article of the year, found that over  a six-year period, 2009 to 2015, use of clinical video telemedicine grew from 30 to 124 encounters per 1,000 veterans, with faster growth among rural veterans than urban ones.  It also found that more than 50 percent of the telehealth visits were for mental-health care.

The study adds that in fiscal year 2015, the last year of the study, 3.2% of urban and 7.2% of rural veterans used telemedicine for nearly 725,000 clinical encounters.

The authors said vets were more likely to use telemedicine if they had a "younger age, longer driving distance to VHA facilities," or multiple medical conditions.

The study concludes that the availability of telemedicine "has likely increased access to care for rural veterans, especially for mental-health care."

The challenge of broadband access that is needed to facilitate telemedicine is not just a problem for rural America, but also in tribal nations.

A letter to the editor in the same journal speaks of barriers to health care among tribal nations in the Southwest: "It is likely that the covid-19 pandemic will exacerbate disparities among American Indian tribes, particularly when coupled with existing barriers to access health services."

The authors point to commentary that provides a history of the many challenges Native Americans have had with infectious diseases, as well as those that currently exist amidst the covid-19 pandemic, and points to telemedicine as a way to address this.

But they note the ongoing challenges that exist around broadband internet services, and summarize the Census Bureau's American Community Survey 2018 estimates for census tracts with the largest tribe in the U.S.: "58.1% to 87.7% of households in Navajo Nation census tracts reported not having broadband internet services, compared to 19.6% nationally." Even if Native Americans have internet access, these locations are not ideal for telehealth visits, especially if related to mental health, they write.

Editor/publisher of small Missouri paper steps down after running cartoon he acknowledges as 'racially insensitive'

William Miller was 87 when he accepted the Eugene Cervi Award
from the International Society of Weekly Newspaper Editors at
the University of Maryland on July 1, 2017. (Photo by Al Cross)

William Miller Sr., longtime editor and publisher of the weekly Washington Missourian, stepped down after 67 years on Wednesday after the outrage following his decision to run a syndicated cartoon he now acknowledges is "racially insensitive." Washington, pop. 13,892, is just west of St. Louis, in Franklin County.

Michael Cavna of The Washington Post writes: "In the cartoon, by Tom Stiglich of Creators Syndicate, a light-skinned woman screams, 'Help!! Somebody call 911!' A darker-skinned man who is attempting to snatch her purse says: 'Good luck with that, lady. … We defunded the police,' a reference to a proposal that some activists have put forward to reform law enforcement."

After the cartoon ran, two of Miller's daughters, Missourian co-owners and editorial staff members Susan Miller Warden and Jeanne Miller Wood, published a message apologizing to readers. Warden and Wood said they had no knowledge that the cartoon would be published and said they were "just as outraged and horrified" as the staff and community. Both resigned in protest that day, Sarah Teague reports for the St. Louis Post-Dispatch.

Miller published a post later that day apologizing for "poor judgment" and saying he had intended only to highlight his opinion that "defunding police departments in the aftermath of George Floyd’s senseless killing is not the answer to resolving the racial inequities and injustices that have occurred in policing in this country." Miller promised the paper would no longer run cartoons by Stiglich.

At some point that day, Miller resigned. The next day, the Missourian announced that a third daughter, Tricia Miller, was the paper's new interim editor and publisher. She recently retired as publisher of the St. Louis Business Journal after 33 years with that publication.

Rural utility co-ops could bridge the digital gap, says report from group that promotes local-government solutions

Institute for Local Self-Reliance map; for a larger version, click on it.

Locally owned utility cooperatives already play an important role in providing basic services to rural households, but they could also help bridge the digital gap by bringing fiber-optic broadband to underserved rural areas, according to a new report from the Institute for Local Self-Reliance, which advocates for local-government solutions. 

According to the study, 26 percent of rural Americans have no fiber-optic service available, compared to only 2% of urban residents. That jibes with a 2019 study by the Purdue Center for Regional Development. Fiber optic is the fastest form of broadband, and rural co-ops are more likely to provide it. Larger telecommunications companies often win large federal bids to build out rural broadband, then save money by using the slower (and cheaper) Digital Subscriber Line technology, which uses phone lines, ILSR says. The Federal Communications Commission defines broadband as internet with speeds of at lest 25 megabits per second downloads and 3 Mbps upload.

As of June 2019, rural utility co-ops provided up to 30% of fiber-optic services in rural America, according to FCC data. But since those numbers don't reflect build-outs that are in progress, the number is likely higher. The report highlights success stories and recommends policies to help rural co-ops expand, receive more state and federal funding, and more easily serve as internet providers.

"The report stresses the outsized role the co-ops play in providing basic services to rural households. Electric cooperatives maintain 42% of the electric distribution lines in the United States, serving 20 million entities, from homes to farms, 'providing reliable power to 56% of the entire U.S. land area, accounting for 42 million people in 48 states,'" Jan Pytalski reports for The Daily Yonder. "More than 30 states have at least one telephone cooperative, according to the report."

Quick hits: Coal strike inspires novel; study examines whether broadband connection increases rural homes' value

Here's a roundup of stories with rural resonance; if you do or see similar work that should be shared on The Rural Blog, email us at heather.chapman@uky.edu.

Commentary: Policies hamstring federal investment in rural small businesses. Read more here.

Oklahoma study assesses whether better broadband connection increases a rural home's value. Read more here.

Montana tribal nations continue shutdowns and stay-at-home orders to protect against the pandemic, which has disproportionately hit Native Americans on reservations. Read more here.

Real-life coal strike in Pennsylvania inspires new novel. Read more here.

Church in rural England posts want ad for journalist

Newspapers all over the world, especially smaller local ones, are suffering from declining advertising revenues in the wake of the pandemic. Initiatives such as Giving NewsDay and Support Local News have been launched to encourage the public to subscribe, advertise and donate to local newsrooms, and some have suggested government funding via for public-service announcements but one rural British church has a more straightforward idea: it's hiring its own journalist.

St. Margaret's Church in Rainham, a town in the southeastern county of Kent (near the White Cliffs of Dover) has posted a want ad for a full-time journalist to write stories, some about the church and some about the community. The position pays £20,000, which is almost $25,000, Harriet Sherwood reports for The Guardian.

The church posted the ad after surveyed parishioners said they wanted more local news. "For thousands of years, it is storytelling which has kept communities together. Now, more than ever before we need someone like you to tell our stories so that we might stay together even when physically we are apart," the ad says. "Whether it’s telling the story of the local fish shop, how the restaurant owners are coping whilst shut or the history behind The Oast House and what it’s doing now – we want a multi-skilled, qualified journalist to join our staff team as soon as possible."

"This is one of the best testimonies I have ever seen for the need and desire for local news," said Al Cross, director of the Institute for Rural Journalism and Community Issues, which publishes The Rural Blog. "The solution isn’t ideal, but it should make us think about better ways to support local journalism."

Etsy helps drive rural sales of hand-made foods

Etsy is a website better known for selling crafts, but it's also becoming an increasingly helpful platform for rural entrepreneurs who want to sell homemade foods and goods—including face masks—online.

Changes in state laws have made it possible. "From 2013 to 2018, 10 states passed so-called 'cottage food laws' allowing home bakers to legally sell their goods in a variety of venues, including online," Christopher Mims reports for The Wall Street Journal. "Many other states amended existing food laws."

Read more here.

Rural hospitals ramping services back up — but carefully

In the midst of the pandemic, hospitals nationwide (including rural ones) have shut down elective procedures to limit the spread of the coronavirus, preserve personal protective equipment and keep from being overwhelmed by a surge of covid-19 patients. But as states have loosened restrictions, rural hospitals are trying to navigate the challenges of reopening while observing new pandemic safety protocols—often with less money and fewer resources than larger hospitals.

"Across the country, rural areas are on the forefront of the political and economic movement to reopen, but these areas are not immune to their own struggles with the virus," Laura Benshoff reports for Philadelphia NPR affiliate WHYY.

"For rural hospitals in particular, managing the process of reopening is both fraught and necessary. In the early days of the pandemic, hospitals braced for a surge in infections that could risk overwhelming their services. For rural Wisconsin, that surge didn't come," but it still could, Rob Mentzer reports for Wisconsin Public Radio. "The new normal at these hospitals includes coronavirus testing for all patients ahead of even routine, unrelated procedures, because some carriers of covid-19 are asymptomatic. Hospitals physically separate the areas where covid patients are treated from those where they conduct routine testing, surgeries or other procedures. And everyone, patient or staff, is required to wear a mask."

A second wave of coronavirus cases could overwhelm rural hospitals; that's in danger of happening in Chambersburg, pop. 50,000, in Pennsylvania. Days after Gov. Tom Wolf announced he would ease restrictions on gatherings in Franklin County, covid-19 cases filled the intensive care unit at WellSpan Chambersburg Hospital, Benshoff reports. A physician told Benshoff that the ICU has been operating at near capacity for weeks, and a few more cases would "tip the balance" and overwhelm the hospital.

"As public officials across the country decide whether to ease social distancing restrictions, economic devastation is weighed against the likelihood of loss of life," Benshoff reports. "In Franklin County, momentum has tipped toward reopening but public opinion on the ground falls far short of consensus and some local doctors question the decision."

Rural hospitals and communities are facing the same quandary in Washington state. Gov. Jay Inslee allowed medical providers to do elective and non-urgent procedures on May 18, as long as they use personal protective equipment and other safety and sanitation procedures to limit the spread of the virus, Arielle Dreher reports for The Spokesman-Review in Spokane.

"Hospital officials hope the change will not only help them provide better care, but also help them stabilize their institutions," Drehere reports. "The drop in patients, combined with the costs of trying to acquire PPE, prepare for covid-19 patients and purchase testing materials, led to financial decline, at times swiftly, for rural hospitals.

Grain bin accidents and deaths up because of wet weather

Reported grain bin entrapments and deaths have increased because of last year's record wet weather. Nationwide, grain bin entrapments increased by 27 percent (from 61 to 67 incidents) and deaths increased by 53% (from 26 to 39) from 2018 to 2019. The trend could continue this year because of similar weather early on.

"Heavy rainfall and brisk harvest conditions throughout 2019 across the 10-state 'corn belt' that includes South Dakota led many farmers to harvest grain crops later than usual and produce grain that was immature or damper than normal," Bart Pfankuch reports for South Dakota News Watch. "Those factors from the 2019 harvest, in addition to the use of old, leaky bins on some farms, have combined to reduce the quality of grain being stored and result in a product known as “'out-of-condition' grain."

Such grain is more likely to clump together and less likely to flow freely from the bin, meaning farmers are more likely to have to go into the bin to try to fix the plug, Pfankuch reports. Owners of small farmers are more susceptible to grain bin entrapments because federal workplace safety laws aren't enforced on farms with 10 employees or fewer.

Earlier this year, a Nebraska farmer announced he'd invented a relatively inexpensive and easy to install machine that could help prevent grain-bin deaths by making it unnecessary for farmers to enter a grain bin to break up the clump. Read more here.

Iowa passes its third 'ag-gag' law, focused on trespassing

On Friday, Iowa state legislators passed a bill that would penalize undercover animal-rights activists who expose conditions on factory farms, buried in an agriculture bill that mostly addressed pandemic-related concerns. On Wednesday, Republican Gov. Kim Reynolds signed it.

The law, sought by the Iowa Pork Producers Association and sponsored by State. Sen. Ken Rozenboom (a factory farm owner), is the third try for a so-called "ag-gag" law. "The first version was overturned on First Amendment grounds in January 2019, and the second was put on hold while a constitutional challenge moves through the courts," Alleen Brown reports for The Intercept.

The law establishes a new crime, "food operation trespass," that would penalize anyone who enters without permission a place where meat is processed or sold, or any place where a "food animal" is kept. "A first-time trespasser would now face up to two years of incarceration and a fine of up to $6,250," Brown reports. "If they entered a farm without authorization a second time, they could be charged with a felony carrying up to five years’ imprisonment and a fine of up to $7,500."

At least two dozen other states have introduced similar bills; in a handful of states, the laws have stuck, and in Idaho, Kentucky, Utah and Wyoming they've been overturned by courts, Brown reports.

Tyson gets immunity in poultry price-fixing probe

In return for its cooperation Tyson Foods has gained immunity from prosecution in the Justice Department's investigation into whether major poultry processors illegally colluded to fix the price of broiler chickens. "Under a program run by the department’s antitrust division, a company can receive immunity if it’s the first member of a price-fixing cartel to inform federal prosecutors," Ryan McCrimmon reports for Politico's Morning Agriculture.

Four poultry executives from Pilgrim's Pride and Claxton Poultry Farms were indicted last week on charges that they fixed prices and rigged bids on broiler chickens sold to grocery chains and restaurants from 2012 to 2017. "All four individuals have pleaded not guilty, and the trial is set for August, McCrimmon reports.

The DOJ began investigating meat processors in recent weeks after farmers and ranchers complained that processors have been paying them extremely low prices for their livestock, even though meat prices (especially beef) surged for buyers, Leah Nylen and Liz Crampton report for Politico.

$15 million ad campaign launched with money from Google to encourage public to support local news media

A $15 million "Support Local News" ad campaign launched yesterday in an effort to raise awareness about the need and importance of funding local newsrooms in the U.S. and Canada through subscriptions, donations and advertising, according to a press release.

The campaign is a collaboration between Local Media Consortium and Local Media Association, with funding from the Google via its Google News Initiative. The campaign will run for six weeks in newspapers, TV, radio stations, and news websites, encouraging people to visit the Support Local News website where they can find links to local news sources that need support, and can also donate to a fund supporting local investigative reporting in North American newsrooms. Donors can also designate contributions for publishers of color doing investigative reporting.

The ad campaign is meant to boost local news sources hurting from decreased ad revenue during the pandemic—a problem the public is largely unaware of. More than 30 local newsrooms have closed since the pandemic began, but a Pew study found that 71% of consumers think their local news media outlets are doing well financially.

Community Newspaper Holdings converts three papers to online-only after merging (in effect closing) several others

Community Newspaper Holdings Inc., which recently "merged" or closed newspapers in Alabama, Indiana, Iowa, Kentucky and Oklahoma, has converted a daily and a weekly in Southern Kentucky to online-only, following the strategy it recently took with a daily in Eastern Illinois.

Glasgow Daily Times publisher Bill Hanson announced Tuesday that the day's print edition would be its last, due to "steep losses in revenue" from the coronavirus pandemic "on top of burdensome print delivery costs, newsprint and ink expenses, and the production outlay required to run the presses. We urge Daily Times subscribers to continue to support the newspaper online."

Last week, giving identical reasons, CNHI did likewise with the Wayne County Outlook, a weekly in Monticello, which operates as a satellite of its daily Commonwealth-Journal in Somerset. The daily is now in a position to get the public-notice advertising for the county.

Glasgow will still be served by a weekly, the Barren County Progress, owned by a small regional group, Jobe Publishing Inc., which is owned by Jeff Jobe, this year's president of the Kentucky Press Association.

CNHI has taken the online-only strategy with one other paper, the Shelbyville Daily Union in Illinois. Its primary strategy has been to "merge" smaller papers into larger ones, in effect closing them. That began in Alabama in April, when the North Jefferson News in Gardendale was merged with The Cullman Times. The towns are 40 miles apart and in non-adjacent counties.

That looked much like the May merger of The Morehead News and two other weeklies in northeastern Kentucky with CHNI's Ashland Daily Independent. In Indiana, the company merged the Batesville Herald-Tribune and the Rushville Republican into the Greensburg Daily News, and the Zionsville Times-Sentinel into the Lebanon Reporter; in Iowa, it merged the Centerville Iowegian into the Ottumwa Courier, and The Pella Chronicle and the Knoxville Journal Express with the Oskaloosa Herald; and in Oklahoma, it folded the Edmond Sun into the Norman Transcript, though the two towns are on opposite sides of Oklahoma City.

CNHI news vice president Bill Ketter told The Rural Blog, "Again, the reason is financial, tied to insufficient local advertising and subscribers. We are providing news coverage of these communities by the merged newspaper. CNHI’s goal is to save newspapers and serve our local communities in the best way we can. But given the overall economic challenges facing the newspaper industry, we cannot operate our smallest markets at a financial loss. Thus the alternatives of digital only and merged newspapers."

Rural Americans just as worried about pandemic as national average, according to new poll

Early on in the pandemic, rural Americans as a whole tended to be more skeptical about the coronavirus pandemic than their urban and suburban counterparts, a difference driven mostly by political ideology. But a new nationwide online poll shows that most rural residents are taking the pandemic seriously these days, Tim Marema reports for The Daily Yonder. The poll was conducted from April 24-26 by Civis Analytics and funded by the Bill & Melinda Gates Foundation.

According to the poll, nearly 90 percent of rural respondents said they will probably continue social distancing and other precautions even when their state begins to lift mandatory restrictions. "About three-quarters of rural respondents said they are somewhat or very concerned about the coronavirus," Marema reports. "The response from rural participants was slightly lower than the national response. But the 3-point gap is within the poll’s margin of error, meaning the rural and national responses are statistically indistinguishable."

Other results from the poll:

• About half of rural respondents, about the same as the nationwide average, agreed that their state has taken appropriate action to contain the pandemic.
• Only 5-6% of rural and national respondents said the government has overreacted to the pandemic.
• About three-quarters of rural and national respondents said they've avoided crowds and public spaces during the pandemic.
• About two-thirds of rural and national respondents said they're committed to social distancing.
• Rural attitudes toward the pandemic varied by region: rural Southerners were more likely to wish their states were doing more to control the pandemic than rural Northeasterners.
• About one-third of rural respondents said they're very unlikely to lose their job because of the pandemic, compared to about one-quarter of national respondents.
• About one-quarter of rural people of color said they were unlikely to lose their job because of the pandemic, compared to more than half of rural whites. 
• Rural and national respondents reported similar levels of trust in information sources except when it came to info provided by President Trump or Vice President Pence. Nationwide, 45.4% of respondents said they trust info from the president or vice president, compared to more than 55% of rural respondents.

Alabama nixes controversial charter school just before opening, the first time the state has shut down a charter

"A controversial public charter school in south Alabama met its end today, two months before opening," Trisha Powell Crain reports for Alabama.com. After a half-hour closed session, the Alabama Public Charter School Commission voted to revoke the charter for Woodland Preparatory School in Chatom "for failing to meet conditions of pre-opening, lack of adherence to generally accepted financial standards, and failing to establish community support for the school."

That was two weeks after a hearing in which school representatives explained at a hearing why they haven't been able to meet the commission's conditions. The school was first approved in May 2018 and scheduled to open this August, but in February the commission voted to begin the revocation process, Crain reports. The move marks the first time the state commission has revoked a school's charter. There are currently four public charter schools operating in the state under the commission's authority.

The for-profit rural school, first approved in May 2018, has been beset with controversy since the beginning, plagued by local worries that the charter would drain tax money from local public schools. Locals were also concerned that a national organization that evaluates charter school applications gave the for-profit charter was given a failing grade. Some locals were also worried because the school would have been part of an informal network of charter schools run operated by followers of a Turkish Muslim preacher living in Pennsylvania. 

In rural town, virus threatens vital summer tourist revenue

A rural tourist town in north-central Washington state illustrates the consequences of the pandemic and the controversy it can cause among locals trying to keep the town afloat while staying safe.

Winthrop, Washington, which has fewer than 500 residents, depends on an influx of summer tourists who use the town as a jumping off point for hiking, biking, and mountain climbing nearby, Bill Lucia reports for Route Fifty. At least two dozen counties in the state have been approved for lighter restrictions, but Gov. Jay Inslee has still advised people to limit non-essential travel, including to tourist towns.

"Despite recommendations like this, tourist traffic will likely continue to flow into towns like Winthrop as the state eases virus-related restrictions and people who’ve been cooped up venture out, seeking to take advantage of long days and beautiful summer weather," Lucia reports. "It’s a set of circumstances many rural tourist destinations are apt to face in the months ahead."

Tourists flocked to Winthrop on Memorial Day weekend, and while some locals told Lucia they were grateful for the increase in revenue, others said most tourists weren't social distancing or wearing masks, and they were worried about the pandemic spreading. The area had only five confirmed covid-19 cases since mid-April, but the mayor said a bump in cases could strain scarce local medical facilities.

Republicans moving $900M bill to fix national parks and protect public lands – and two vulnerable GOP senators

Sens. Daines and Gardner (Photo by Tom Williams, CQ Roll Call)

"After decades of frustration over low levels of funding, the nation’s conservation community is on the brink of realizing a long-held goal — legislation that would assure that federal money is available for the preservation of public lands," Carl Hulse reports for The New York Times. "That is thanks to a desire among Republicans to protect what they consider two worthy assets of their own:" GOP Sens. Corey Gardner of Colorado and Steve Daines of Montana, who are in close re-election races.

The bill would fully and permanently fund the Land and Water Conservation Fund at $900 million annually. Moving it "has required an about-face by the president and the grudging cooperation of some Republicans who have long opposed the measure on principle, believing it adds too much to the soaring deficit," Hulse reports. "The legislation cleared a procedural hurdle on Monday by a lopsided vote, 80 to 17, in an indication that it is headed for passage this month. Senator Mitch McConnell of Kentucky, who is eager to hold on to his position as majority leader after November’s elections, has gotten behind the bill . . . He is always careful to credit the two Western senators for the measure that he describes in glowing terms."

The arguments and timing for the bill are more than just political. "Its sponsors note that the pandemic has focused public attention on the need for public space for outdoor recreation, and that the park maintenance aspect alone will provide tens of thousands of jobs in communities that have been hit hard by the loss of tourism," Hulse reports.

Sen. Lamar Alexander, R-Tenn., who was working on a similar bill that is included in the legislation, said in a press release that it would be "the biggest boost to our national parks in 50 years" and cut in half their $12 billion deferred maintenance backlog. He said the Great Smoky Mountains National Park in Tennessee and North Carolina, the most-visited park, "has $224 million of deferred maintenance and an annual budget of $20 million a year." He said that is "a massive disappointment to people who consider our national parks as our greatest treasures – who go to our parks and find a campground closed, a bathroom not working, a bridge that's closed, a road with potholes, a trail that’s worn out or a visitor center that could be dilapidated . . . things that are broken and don't work, and interfere with the ability of the American people to go outdoors."

Rising real-estate sales in rural New York reflect pandemic-spurred urge to get away from city congestion, infection

The pandemic seems to be driving up rural real estate sales in rural areas north of New York City, Lisa Green reports for Rural Intelligence. The trend may be repeated in other states as well.

Even before the pandemic, rising housing prices were already driving urban residents to head for less-populated pastures, but the pandemic seems to have accelerated the trend. Part of the urge to move to more rural areas may come from wariness about living in the close quarters of the city, which can encourage the spread of infection. More relaxed work policies that allow telecommuting are another factor, Brad Cartier reports for Million Acres, a Motley Fool website.

As early as March, a report from real estate brokerage Redfin showed that "the seven-day average change in page views of homes in rural and small towns was up 115% and 88%, respectively. Further, the decline in pending sales was less dramatic in small towns than in urban ones," Cartier reports.

In a nationwide Harris poll conducted in early May, 37% of respondents said the pandemic made them want to live in a rural area more than 21 miles away from a major city.

Democrats wary of aid to farmers being a political tool

As the Department of Agriculture begins distributing $16 billion in direct payments to farmers hurt by the pandemic, many are "raising questions about how the money will be allocated and whether there is sufficient oversight to guard against partisan abuse of the program," Sharon LaFraniere reports for The New York Times. "Months before an election in which some farm states are major battlegrounds, Democrats and other critics of the administration’s agriculture policies are expressing concern that the new subsidies, provided by Congress with bipartisan backing, could be doled out to ensure President Trump continues to win the backing of one of his key voting blocs.

Their worries are based on how the administration distributed $28 billion over the past two years on direct aid to farmers hurt by the trade war with China and lousy weather. Farmers, their lobbying groups, politicians and others have criticized the administration for distributing such funds unequally, saying the program was "excessive, devised on the fly and tilted toward states politically important to Republicans," LaFraniere reports. "Polls suggest that farmers are strongly united in supporting Trump. They are important voting blocs in key swing states like Wisconsin, vital in some states like Iowa that he is fighting to hold, and a core constituency in many other solidly Republican states across the Midwest and South."

Farmers have increasingly relied on federal aid over the past few years; direct federal payments made up an estimated 24 percent of all farm income in 2019.

U.S. oil output increasing as global demand remains down

Though oil and gas drilling in the United States recently hit an 80-year low, and global demand remains down, American oil producers are bringing production back up.

"Scores of shale-drilling companies turned off wells to reduce output when U.S. oil prices fell to negative territory in late April, after millions world-wide stopped driving and flying due to the new coronavirus, causing a steep drop in global demand," Rebecca Elliott reports for The Wall Street Journal. "Now that more of the world is reopening and prices are rebounding to nearly $40 a barrel, companies including Parsley Energy Inc. and WPX Energy Inc. are starting to turn some of those wells back on, even as they continue to put off most new drilling."

Output is still "far below" pre-pandemic peaks, when the U.S. was the world's top producer of crude oil. "While turning existing wells back on is likely to temporarily boost U.S. production this summer, American oil output is still widely expected to drop in 2020," Elliott reports. "That is because shale wells lose steam quickly, and companies have sharply cut back on the number of new wells they are drilling." That will likely continue to hurt the nation's economy, according to analysts.

Global oil demand has increased, though it's still an estimated 13% below last year's levels. On Saturday, the Organization of Petroleum Exporting Countries agreed to extend production cuts for another month to bring prices up. "OPEC delegates were briefed on the likelihood that U.S. producers would turn the taps back on last week," Elliot reports, "but also discussed forecasts that American production would likely decline later in the year before agreeing to extend output cuts."

Rural African Americans are at higher risk from covid-19

Though all population groups have been hit by the coronavirus pandemic, some are at a disproportionate risk of dying from covid-19 in the United States. That includes rural residents and racial/ethnic minorities. Those who are both, especially rural African-Americans, have a much higher risk of being hospitalized and/or dying from the infection, according to a newly published paper in The Journal of Rural Health.

That echoes other studies that have found rural non-whites' overall medical risk to be higher, compounded by their rural location, access and health issues spurred by historical racial inequalities, and unconscious bias from medical providers.

The paper examines three possible explanations for why African-Americans are at a greater risk for covid-19, including social determinants of health (where someone is born, what kind of family they're born in and grow up with, and other factors all influenced by the distribution of money, power and resources), comorbidities and coexposures (underlying health issues and risk factors such as smoking), and genetic differences.

The authors recommend "innovative preventive and therapeutic interventions targeting the rural African American communities" to help fight the spread of covid-19.

Racial justice protests happening in rural areas too

Chad Jones of Holland, Ark. (photo provided)

Thousands of communities, some in foreign countries, have held demonstrations over the past week to protest the deaths of George Floyd, Breonna Taylor, and other people of color at the hands of law enforcement, as well as general racial and ethnic inequality. But such protests aren't limited to big cities: some are happening in small towns.

Some are college towns, like State College, Pa., and Morehead, Ky.; such communities tend to have younger and more liberal residents, Alisha Ebrahimji reports for CNN. Others are smaller, agrarian communities like Holland, Ark., pop. 552. Local farmer Chad Jones staged a one-man protest recently because he wanted to show that "not all small towns come with small minds."

"Demonstrators marched and chanted for racial justice in Corbin, Morehead, Barbourville, Richmond and many more Kentucky cities and towns," the Lexington Herald-Leader reports. Corbin had "a notorious incident in October 1919 in which a white mob forced scores of black people out of town." In Midway, between Lexington and Frankfort, dozens of locals drew anti-racism messages on sidewalks Saturday, the Midway Messenger reports.

Hundreds of residents in small, politically conservative towns in southern Illinois have protested in recent days. As one protester said: "We don’t want Franklin County to be known for its racism. This is more about bringing the community together more than anything else," Molly Parker reports for The Southern Illinoisian.

In Ontario, Oregon, pop. 11,366, hundreds came out for a protest Thursday where local educators, organizers, and government officials gave speeches and shared stories about their experiences with ethnic and gender inequality, Rachel Parsons reports for the Malheur Enterprise.

Maps show spread of covid-19 to rural and Trump counties

New high-prevalence covid-19 counties through April 19 (left) and from April 20-May 31 (right). Brookings maps.

The coronavirus initially hit large urban areas, most of which went for Hillary Clinton in 2016. "However, covid-19 is continuing to spread to more parts of the country; since late April, counties with a high prevalence of cases have transitioned from 'blue' America to 'red,' where arguments for immediate reopening have been more pervasive," William Frey reports for Brookings.

High-prevalence covid-19 counties by population,
March 29-May 31 (Brookings chart)

According to a Brookings analysis, counties that were newly designated as having a high covid-19 prevalence—at least 100 cases per 100,000 people—in the six week between April 20 and May 31 were more rural, less racially diverse, and more likely to have voted for President Trump in 2016 than counties with a high covid-19 prevalence before mid-April, Frey reports.

"Clearly, the demographic attributes of the most recently identified high-prevalence counties are more favorable to Trump, given his popularity in smaller and rural areas and among white voters," Frey reports. Here's a Brookings map showing how high-case counties increasingly became more common in rural areas:

Rural Journalism director: Newspapers must embrace bold, persistent experimentation to survive and thrive

This is the author's latest monthly "Into the Issues" column in Publishers' Auxiliary, the newspaper of the National Newspaper Association.

By Al Cross

Director, Institute for Rural Journalism and Community Issues

Our country may not be in a depression, but the newspaper business is, and its fatality rate may be as great at that of the coronavirus. The pandemic and its economic restrictions have accelerated closures and mergers, which have increasingly affected county-seat weeklies, long the most stable type of American newspaper.

The economy is gradually reopening, but with no vaccine or proven treatment, the virus remains a threat, and that threatens a resurgence of covid-19 cases and more economic reversals. To get through this, newspapers need to prove their value, and they need to try new things.

The pandemic is spawning rivers of misinformation, an if there was ever a time for newspapers to reassert their franchise as the main finders of fact for democracy, this is it. But they must remember to assert that on social media, too, and to remind social-media consumers how those media and newspapers differ.

We must repeatedly explain that news media offer journalism, which has a discipline of verification: we emphasize facts, attribute opinion, and clearly separate the two. (That separation has eroded lately, and needs shoring up.) Social media have almost no discipline and no verification, so the facts get lost in a sea of opinion and invective, driven by algorithms giving people what they want, not what they need. They need to know that.

Don’t like online arguments? This is a fight for your life, so you should wage it on all fronts. Ask your critics to cite specifics, and when they do, remind them that it’s easy to pick examples of bad journalism from thousands of reports. As someone who got into journalism as a youth baseball scorekeeper and correspondent, I like to say journalism has a fielding percentage about as good as Major League players, around .984. By my reckoning, we’re fair and accurate 49 times out of 50. We do make two-base errors sometimes, but unlike social media and ballplayers, we correct them.

Newspapers’ survival depends on more than trust. They must provide value, which means good public-service journalism. How do you pay for that when advertising has dried up? Community newspapers need to be more aggressive in following their metro counterparts in asking their audiences to provide a greater share of revenue, and they need to be frank with their readers about their paper’s finances.

They also need explore a source of revenue that’s becoming more common: philanthropy. It’s unlikely that many community papers will have reporters paid by nonprofits, or get grants from foundations, but in every county in this country, there are people with money who would like to put it to good use. Many of them would define becoming a sponsor of a newspaper, to help it offer good journalism and stay alive, as a good use of their money.

Perhaps the best example of that is the Foothills Forum, a nonprofit in Rappahanock County, Virginia, that finances high-quality, in-depth journalism for the weekly Rappahannock News. The county has more money and more journalists than average, because it’s a little over an hour from Washington, D.C., but its paper has more than four years of experience that could provide guidance for others. We’ve written about it several times on The Rural Blog.

Philanthropists often want to help students, and that includes student journalists. When many University of Missouri journalism students’ internships fell through, faculty members Kathy Kiely and Damon Kiesow created a pop-up newsroom to produce stories for news outlets across the state, with students paid with funds from the school, the Knight Foundation and alumnus Walt Potter. As paid internships have become less common, students are accepting unpaid internships at community papers, and the relationship is mutually beneficial.

Universities can help in other ways. There is scant published research about community newspapers, and state press associations or newspaper groups should get researchers to examine the relationships of community papers and their audiences – including why they are losing readers and how they might get them back.

Another potential source of help is government – not the direct subsidies that are anathema to most journalists, but public-service advertising during the pandemic. In Kentucky, local governments have financed sample-copy editions of weeklies loaded with information about the coronavirus and preventing covid-19, and there is even more reason to do that now, as we need to take care to prevent a resurgence.

Now also might be a good time for a makeover, to spur single-copy sales. Think about a magazine format like The Canadian Record in Texas, which runs a compelling color photo on the front with blurbs about major features. It goes for $1.50 a copy, and folks in Hemphill County snap it up, because they know it’s good journalism.

Many other ideas are out there, in Pub Aux, state press groups and the International Society of Weekly Newspaper Editors’ online discussion board and monthly newsletter. The May edition had ideas on advertising, covering covid-19, online journalism, dealing with social media and helping communities get through the crisis.

Ideas are what we need. Not all will work, but our industry is at a juncture much like the bottom of the Great Depression, when presidential candidate Franklin D. Roosevelt called for “bold, persistent experimentation.”

That’s not something for which newspapers are known, especially community papers, but they’d do well to follow it. After all, FDR’s line was written by a newspaper reporter, Ernest K. Lindley of the strongly Republican New York Herald Tribune. When Lindley and other reporters chided him about the lack of zing in his pre-convention remarks, FDR challenged them to draft a speech. “Lindley took the bait,” wrote presidential historian James MacGregor Burns, and bold, persistent experimentation helped save the country. It might save newspapers, too.

Most counties lost jobs in April, but rural counties lost a smaller percentage of theirs; county-level data available

Job losses from March-April 2020; differences among states may reflect policies on unemployment benefits and other factors. (Daily Yonder map; click on the image to for a larger version, or click here for the interactive version)

"Just about every corner of the country lost huge numbers of jobs between March and April of this year, but rural places fared far better than the nation’s largest cities," Bill Bishop reports for The Daily Yonder. "April was the first full month of lockdowns and business closings due to the covid-19 outbreak, so nearly every county suffered job losses. But the decline in employment diminished as one moved away from the centers of the nation’s largest cities, according to employment data just released by the federal Bureau of Labor Statistics."

Specifically, the most rural counties (those that touch no metropolitan area) lost 10.8 percent of their jobs, rural counties near metro areas lost 11.7%, and the largest metro counties lost 15.1% from March to April, Bishop reports. Rural economies dependent on farming lost 7% of their jobs in that time period, compared to rural counties dependent on recreation, which lost 13.3% of their jobs.

Read more at the Yonder for a deeper statistical breakdown among rural-urban lines.

Editor's view: What journalists do, and how they should do it

By Jim Zachary
    Journalists play an important role during volatile times, mass protests and racial discord.
    Journalists give voice to the voiceless.
    Journalists write the first draft of history.

    Journalists share the pain, the angst and the frustrations of the people they cover, through their words.
    Journalists provide context.
    Journalists report on and help explain the positions of those in power.
    Journalists can provide a bridge between polarized communities and individuals through dispassionate reports.
    The role of the journalist is to chronicle events as they unfold.
    Journalists should be unimpeded by the authorities and should always have full access, free to report exactly what happens on the streets, in neighborhoods and in the halls of government.
    In turn, journalists should be professional and go about doing their jobs while maintaining high standards of journalistic ethics and conduct.
    The role the journalist plays is not in carrying signs, chanting slogans or marching in the streets.
    Journalists do their jobs with words.
    Their words can be powerful.
    Their words can effect change.
    Their role is to observe, to listen and to learn.
    Their role is to report.
    Their role is to speak — or write — truth.

    Their role is to tell the stories unfolding all around them.
    They are not present to take sides. Their side is the side of truth.
    Not everyone will like the truth they tell or the stories they share, but dedicated journalists persevere, not as activists, but as truth tellers.
    Sometimes journalists are attacked.
    Some have even been attacked by police — pushed, hit, shoved and arrested.
    That is wrong and police must be held accountable when they strong arm the press. The freedom of the press to cover and report is guaranteed by the First Amendment and crucial to an open and free society.
    Far more journalists are attacked in public spaces and on social media by people who simply do not like the truth.
    Simple straightforward reporting often conjures cries of “fake news” and “enemy of the people.”
    News reporting that people simply do not like is erroneously labeled “fake.”
    Reporters who are doing little more than chronicling the things they see and hear are called “enemies.”
    The women and men — the journalists — at your local newspaper are someone’s daughter, son, mother, father, brother or sister. They are people you know, people who live in the community. You might sit next to them at ball games or church services. They may be shopping in the grocery store beside you or eating at the table next to you in a restaurant.
    They cover your child’s school play or ballgame. They share news about a fundraiser of a nonprofit you volunteer with or write a compelling feature story inspiring philanthropy and incubating a spirit of generosity.
    They are, most certainly, not your enemy.
    Journalists do hold the powerful accountable and expose nefarious acts. They investigate corruption, keep an eye on the public purse and defend the public’s right to know.
    While they are not working in laboratories to develop a cure for a global pandemic or in harm’s way on the frontlines of a battlefield in a war-torn country defending freedom, they are providing vital services, viz. celebrating community, reporting facts and demanding accountability.
    Journalists are the friends of democracy, friends of justice — friends of the truth.

Jim Zachary is Deputy National Editor of Community Newspaper Holdings Inc., editor of The Valdosta Daily Times and president of the Georgia First Amendment Foundation. He can be reached at jzachary@cnhi.com.